Clinical Results of Technique for Double Bundle Anterior Cruciate Ligament Reconstruction Using Hybrid Femoral Fixation and Retroscrew

Abstract

BackgroundAnatomic anterior cruciate ligament (ACL) reconstruction has been presented as a means to more accurately restore the native anatomy of this ligament. This article describes a new method that uses a double bundle to perform ACL reconstruction and to evaluate the clinical outcome.MethodsGrafts are tibialis anterior tendon allograft for anteromedial bundle (AMB) and hamstring tendon autograft without detachment of the tibial insertion for posterolateral bundle (PLB). This technique creates 2 tunnels in both the femur and tibia. Femoral fixation was done by hybrid fixation using Endobutton and Rigidfix for AMB and by biointerference screw for PLB. Tibial fixations are done by Retroscrew for AMB and by native insertion of hamstring tendon for PLB. Both bundles are independently and differently tensioned. We performed ACL reconstruction in 63 patients using our new technique. Among them, 47 participated in this study. The patients were followed up with clinical examination, Lysholm scales and International Knee Documentation Committee (IKDC) scoring system and radiological examination with a minimum 12 month follow-up duration. ResultsSignificant improvement was seen on Lachman test and pivot-shift test between preoperative and last follow-up. Only one of participants had flexion contracture about 5 degrees at last follow-up. In anterior drawer test by KT-1000, authors found improvement from average 8.3 mm (range, 4 to 18 mm) preoperatively to average 1.4 mm (range, 0 to 6 mm) at last follow-up. Average Lysholm score of all patients was 72.7 ± 8.8 (range, 54 to 79) preoperatively and significant improvement was seen, score was 92.2 ± 5.3 (range, 74 to 97; p < 0.05) at last follow-up. Also IKDC score was normal in 35 cases, near normal in 11 cases, abnormal in 1 case at last follow-up.ConclusionsOur new double bundle ACL reconstruction technique used hybrid fixation and Retroscrew had favorable outcomes.

Complications following Suture Button Use for Femoral Graft Fixation in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Systematic Review

“…Displacement outside the femoral tunnel SB within the lateral vastus muscle 3 Kondo et al 5 SB not seated on the outer cortex 58 Kim et al, 8 Mae et al 10 Lee et al 14 SB migration from the initial location 111 Mae et al, 10 Uchida et al, 13 Ibrahim et al, 15 Gelber et al 17 Abbreviation: SB, suture button. The Journal of Knee Surgery the most common reported complication, and intraoperative screening or direct arthroscopic visualization may help reduce its occurrence; we would recommend these in routine clinical practice.…”

“…Our findings suggest that although in many cases suture button related complications do not adversely affect the outcome of ACL reconstruction, in some cases they may confer substantial morbidity to the patient and require further surgery. Button misplacement is 5 Brucker et al, 6 Kim et al, 8 Karaoglu et al, 9 Mae et al, 10 Muneta et al, 11 Muneta et al, 12 Uchida et al, 13 Lee et al, 14 Ibrahim et al, 15 Nag and Gupta, 16 Gelber et al, 17 Ho and Lee, 19 Sargın et al 20 Intraoperative instrument breakage 2 Price et al, 3 Lee et al 14 Breaking of the posterior cortex of the femoral tunnel in the posterolateral bundle 2 M u n e t ae ta l 11 Pain and soft tissue irritation 12 Taketomi et al, 4 Crawford et al, 7 Petit and Millett, 18 Muneta et al 12 Myxoid tumor (reactive) 1 Gelber et al 17 Abbreviation: SB, suture button. 2 Brucker et al, 6 Muneta et al, 11 Ho and Lee, 19 Sargın et al 20 In femoral tunnel 1 Karaoglu et al 9 Displacement outside the femoral tunnel SB within the lateral vastus muscle 3 Kondo et al 5 SB not seated on the outer cortex 58 Kim et al, 8 Mae et al 10 Lee et al 14 SB migration from the initial location 111 Mae et al, 10 Uchida et al, 13 Ibrahim et al, 15 Gelber et al 17 Abbreviation: SB, suture button.…”